Characterization of small renal lesions: Problem solving with MRI Gary Israel, MD

Size: px
Start display at page:

Download "Characterization of small renal lesions: Problem solving with MRI Gary Israel, MD"

Transcription

1 Characterization of small renal lesions: Problem solving with MRI Gary Israel, MD With the widespread use of cross-sectional imaging, many renal masses are incidentally found. These need to be accurately characterized as either lesions potentially requiring surgery such as renal cell carcinoma or as nonsurgical lesions including cyst, angiomyolipoma, abscess, hematoma, lymphoma, or metastasis. MRI and CT can both accurately characterize renal masses and frequently, both exams are complimentary to each other. Advantages of CT include a short imaging time, familiarity to referring clinicians, the ability to detect calcium and to quantify enhancement. The advantages of MRI include better intrinsic soft tissue contrast, primary multiplanar capability, lack of radiation exposure, and safer contrast material. MRI is especially useful in those patients who require follow-up imaging studies and who would otherwise be exposed to additional radiation and iodinated contrast material during follow-up CT exams. This includes patients with indeterminate cystic masses, with a history of renal cell carcinoma, and with a genetic predisposition (Von Hippel- Lindau) to develop renal cell carcinoma. The concepts of evaluating a renal mass with MR imaging are the same as those used in CT. An enhancing mass indicates a vascular mass, which is indicative of a neoplasm. A combination of T1-weighted images with and without fat saturation and T2-weighted images should be obtained prior to gadolinium administration. This is followed by fat suppressed T1-weighted images after gadolinium. Diffusion weighted imaging may also

2 be performed and there is early evidence that this may be helpful in characterizing renal masses. The capability of acquiring images and any plane helps demonstrate the relationship of a mass to its surrounding tissues, which aids the urologist at the time of surgery. Enhancement of a renal mass may qualitatively be demonstrated by comparing images prior to and after gadolinium. By keeping these imaging parameters constant, it is often possible to appreciate enhancement of a renal mass. However, this may not be feasible when the mass is hypovascular or demonstrates hyperintense signal on precontrast T1- weighted images, usually secondary to hemorrhage. It is then necessary to utilize a subtraction algorithm to assess lesion enhancement. Renal cysts demonstrate uniform hyperintense signal on T2-weighted sequences and may have variable signal intensity on T1-weighted sequences secondary to their contents. After gadolinium administration, enhancement is not observed and subtraction images will demonstrate uniform hypointense signal. Renal cell carcinoma demonstrates variable signal intensity on T1-weighted and T2- weighted images. Therefore, the diagnosis of renal cell carcinoma rests on defining an enhancing renal mass that does not contain macroscopic fat. 3D fat suppressed T1- weighted GRE sequences performed before and after contrast material enables optimum demonstration of a neoplasm and its relationship to the surrounding kidney. After gadolinium administration, imaging can be performed during a corticomedullary phase which can give us qualitative information about the function of the kidneys and also produces an MR angiogram. This acquisition is also useful in identifying hypervascular tumors as well as pseudotumors including hypertrophied columns of Bertin. A second

3 acquisition occurs during the nephrographic phase of enhancement. This part of the examination is useful in identifying any enhancement of a renal mass. In addition, the renal venous anatomy and the possibility of venous invasion can be evaluated. If necessary, a final acquisition may be obtained during the excretory phase to help define the relationship of the neoplasm to the collecting system. After an enhancing renal mass is identified, it is necessary to stage the neoplasm. MRI can accurately demonstrate enlarged lymph nodes and vascular invasion. Angiomyolipoma (renal hamartoma), a benign tumor, is composed of varying amounts of fat, smooth muscle, and blood vessels. They are uncommon lesions with a prevalence of 0.3% - 3% and occur more commonly in women than men. Angiomyolipomas occur in 2 different clinical scenarios. More commonly, they are sporadic (80%), however, they may be associated with tuberous sclerosis (20%) in which they tend to be multiple and bilateral. Patients are usually asymptomatic and angiomyolipomas are usually incidentally discovered when the patient is imaged for another reason. However, when large, angiomyolipomas may exert mass effect on the adjacent organs and cause symptoms. In addition, patients with large angiomyolipomas may present with acute flank pain caused by spontaneous hemorrhage. This may be life threatening and require emergent laparotomy. Angiomyolipoma is the only renal tumor that may be characterized on the basis of its tissue composition and signal characteristics. The relative amounts of fat, smooth muscle and vessels within the tumor will establish its MR imaging appearance. The diagnosis of angiomyolipoma rests on demonstrating the presence of macroscopic fat within the lesion. When an angiomyolipoma is predominately composed of fatty tissue, it will

4 demonstrate hyperintense signal on the T1-weighted images. However, other renal masses including hemorrhagic cysts may also show similar signal characteristics. It is therefore imperative to compare the T1-weighted images obtained with frequencyselective fat-suppression to those obtained without fat-suppression, to establish the presence or absence of macroscopic fat. The use of frequency-selective fat-suppression is essential, as hemorrhage and other tissues with a short T1 will lose signal on inversion recovery pulse sequences and may be erroneously diagnosed as containing fat. Some angiomyolipomas contain only a tiny amount of macroscopic fat and therefore, a concerted effort should be made to identify even small amounts of fat. In rare instances these lesions may not contain any fat. In such cases, the diagnosis of angiomyolipoma cannot be made and the lesion is indistinguishable from a renal cell carcinoma. Angiomyolipoma may also be diagnosed with the use of chemical shift imaging techniques. This technique provides images when fat and water signal are in phase (additive) or out of phase (destructive). This produces the characteristic India ink artifact on the T1-weighted out of phase images, manifested as a low signal intensity rim at any soft tissue (water) and fat interface. Both hemorrhagic cysts and angiomyolipomas are hyperintense on T1-weighted in phase images and may be indistinguishable from each other. However, they are readily differentiated on the T1-weighted out of phase images. For angiomyolipomas, the India ink artifact appears at the interface of the tumor (fat) with the kidney (water). For hemorrhagic cysts, the India ink artifact occurs at the interface of the cyst (fluid) and the perirenal fat (fat), not at the interface of the cyst and the kidney.

5 Caution should be used in diagnosing a renal mass as an angiomyolipoma if it loses signal on out of phase imaging, as clear cell carcinoma of the kidney may show identical findings. However, clear cell carcinoma does not contain bulk fat, and will not lose signal on a frequency-selective fat suppressed T1-weighted images. Suggested Readings Rofsky NM, Bosniak MA. MR Imaging in the Evaluation of Small (<3.0cm) Renal Masses. MRI Clinics of North America Feb. 1997; Choyke PL, Walther MM, Wagner JR, Rayford W, Lyne JC, Linehan WM. Renal Cancer: Preoperative Evaluation with Dual-Phase Three-Dimensional MR Angiography. Radiology 1997; 205: Ho VB, Allen SF, Hood MN, Choyke PL. Renal masses: quantitative assessment of enhancement with dynamic MR imaging. Radiology 2002; 224: Israel GM, Krinsky GA. MRI of the kidneys and adrenal glands. Radiol Clin North Am Jan;41(1): Israel GM, Hindman N, Bosniak MA. Comparison of CT and MRI in the evaluation of cystic renal masses. Radiology 2004; 231: Hecht EM, Israel GM, Krinsky GA, Hahn WY, Kim DC, Belitskata I, Lee VS. MR

6 imaging of renal masses: Comparison of quantitative enhancement using signal intensity measurements versus qualitative enhancement with image subtraction. Radiology 2004; 232: Shinmoto H, Yuasa Y, Tanimoto A, Narimatsu Y, Jinzaki M, Hiramatsu K, Mukai M. Small renal Cell Carcinoma: MRI with Pathologic Correlation. J Magn Reson Imaging 1998; 8: Taouli B, Thakur R, Mannelli L, Babb JS, Kim S, Hecht EM, Lee VS, Israel GM. Diffusion-Weighted MR Imaging for Characterization of Renal Lesions: Comparison with Contrast-Enhanced MR Imaging. Radiology 2009; 251:

When is MRI Useful in Evaluating Renal Masses?

When is MRI Useful in Evaluating Renal Masses? When is MRI Useful in Evaluating Renal Masses? Stuart G. Silverman, M.D., FACR Professor of Radiology Harvard Medical School Director, Abdominal Imaging and Intervention Brigham and Women s s Hospital

More information

Focal Liver Lesions: Characterization with MDCT. Jorge A. Soto, M.D.

Focal Liver Lesions: Characterization with MDCT. Jorge A. Soto, M.D. Focal Liver Lesions: Characterization with MDCT Jorge A. Soto, M.D. CT: Principle Ability to detect a liver lesion depends upon: Relationship between size and section thickness Background organ attenuation:

More information

Kidney Cancer OVERVIEW

Kidney Cancer OVERVIEW Kidney Cancer OVERVIEW Kidney cancer is the third most common genitourinary cancer in adults. There are approximately 54,000 new cancer cases each year in the United States, and the incidence of kidney

More information

Contact Maryann Verrillo Diane Shnitzler (703) 691-1805. Interventional Radiology Treatments for Kidney Cancer

Contact Maryann Verrillo Diane Shnitzler (703) 691-1805. Interventional Radiology Treatments for Kidney Cancer Interventional Radiology Treatments for Kidney Cancer FACT SHEET Contact Maryann Verrillo Diane Shnitzler (703) 691-1805 Kidney cancer is the eighth most common cancer in men and the tenth in women. 1

More information

Renal Cysts What should I do now?

Renal Cysts What should I do now? Renal Cysts What should I do now? Dr Edmund Chiong Asst. Professor & Consultant Department of Urology National University Hospital What are renal cysts? Fluid-filled structures in the kidney that are not

More information

How to Miss a Renal Mass: Guide to Pitfalls and Solutions. MDCT of the Kidneys: Decisions, Decisions, Decisions. Pitfalls in Renal Imaging

How to Miss a Renal Mass: Guide to Pitfalls and Solutions. MDCT of the Kidneys: Decisions, Decisions, Decisions. Pitfalls in Renal Imaging How to Miss a Renal Mass: Guide to Pitfalls and Solutions Elliot K. Fishman M.D. Johns Hopkins Hospital The most common reason for a missed diagnosis in radiology is a perceptual error, or an error in

More information

A912: Kidney, Renal cell carcinoma

A912: Kidney, Renal cell carcinoma A912: Kidney, Renal cell carcinoma General facts of kidney cancer Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type

More information

Hepatobiliary Cystadenoma

Hepatobiliary Cystadenoma Society of Radiologists in Ultrasound 2012 Toshiba Residents Program Felix Gonzalez, MD University of Maryland School of Medicine Baltimore, MD Hepatobiliary Cystadenoma A 27-year-old female presented

More information

REVIEW ARTICLE. Imaging of Cystic and Solid Renal Mass and the Role of MRI. A. Detection of Renal Masses. A. Shirkhoda, MD, FACR 1

REVIEW ARTICLE. Imaging of Cystic and Solid Renal Mass and the Role of MRI. A. Detection of Renal Masses. A. Shirkhoda, MD, FACR 1 REVIEW ARTICLE A. Shirkhoda, MD, FACR 1 Imaging of Cystic and Solid Renal Mass and the Role of MRI W ith the introduction of cross sectional imaging, the diagnostic approach to evaluation of renal masses

More information

The Incidental Renal Mass

The Incidental Renal Mass The Incidental Renal Mass Gary M. Israel, MD a, *, Stuart G. Silverman, MD b KEYWORDS Renal mass Renal cell carcinoma Renal cyst Incidental Angiomyolipoma Incidental renal masses are extremely common.

More information

Thyroid Cancer. This reference summary will help you better understand what thyroid cancer is and what treatment options are available.

Thyroid Cancer. This reference summary will help you better understand what thyroid cancer is and what treatment options are available. Thyroid Cancer Introduction The thyroid is a gland in the neck. Thyroid cancer is a common type of cancer. It accounts for 1% to 5% of cancer cases worldwide. As medical technology advances, more cases

More information

Why Liver Tumors Appear As They Do?: Imaging-Pathologic Correlation

Why Liver Tumors Appear As They Do?: Imaging-Pathologic Correlation Why Liver Tumors Appear As They Do?: Imaging-Pathologic Correlation Pablo R. Ros, MD, MPH University Hospitals of Cleveland Case Western Reserve University Cleveland, Ohio USA XLIV Curso Anual Sociedad

More information

CONTEMPORARY MANAGEMENT OF RENAL ANGIOMYOLIPOMA

CONTEMPORARY MANAGEMENT OF RENAL ANGIOMYOLIPOMA CONTEMPORARY MANAGEMENT OF RENAL ANGIOMYOLIPOMA Stephen A. Boorjian, MD Professor of Urology Vice Chair of Research Director, Urologic Oncology Fellowship Department of Urology Mayo Clinic, Rochester,

More information

Breast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.

Breast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor. Breast Cancer Introduction Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 out of 8 women are diagnosed with breast

More information

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D.

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D. Breast Cancer: from bedside and grossing room to diagnoses and beyond Adriana Corben, M.D. About breast anatomy Breasts are special organs that develop in women during puberty when female hormones are

More information

Medullary Renal Cell Carcinoma Case Report

Medullary Renal Cell Carcinoma Case Report Bahrain Medical Bulletin, Vol. 27, No. 4, December 2005 Medullary Renal Cell Carcinoma Case Report Mohammed Abdulla Al-Tantawi MBBCH, CABS* Abdul Amir Issa MBBCH, CABS*** Mohammed Abdulla MBBCH, CABS**

More information

Radiologic Evaluation of Renal Cysts

Radiologic Evaluation of Renal Cysts Eugene K. Cha, HMS III November 2004 Radiologic Evaluation of Renal Cysts Eugene K. Cha, Harvard Medical School III Renal Anatomy Netter FH. Atlas of Human Anatomy, Second Edition. 2001, p 313. 2 HPI:

More information

After reviewing this module, the student will have the ability to:

After reviewing this module, the student will have the ability to: LEARNING OBJECTIVES After reviewing this module, the student will have the ability to: - Approach History & physical exam of patients with thyroid pathology - Understand which patients require surgery

More information

Radiology Caveats and Pearls in Liver Tumors

Radiology Caveats and Pearls in Liver Tumors Radiology Caveats and Pearls in Liver Tumors Greg de Prisco, M.D. Staff Radiologist Baylor University Medical Center gregdeprisco@gmail.com Liver anatomy 101 Fundamentals of CT & MRI Focal Liver Lesions

More information

Coding Companion for Podiatry. A comprehensive illustrated guide to coding and reimbursement

Coding Companion for Podiatry. A comprehensive illustrated guide to coding and reimbursement Coding Companion for Podiatry A comprehensive illustrated guide to coding and reimbursement 2011 Contents Getting Started with Coding Companion...i Integumentary or Skin...1 General Musculoskeletal...61

More information

How I Do It: Evaluating Renal Masses 1

How I Do It: Evaluating Renal Masses 1 HowIDoIt Radiology Gary M. Israel, MD Morton A. Bosniak, MD Published online 10.1148/radiol.2362040218 Radiology 2005; 236:441 450 Abbreviations: ROI region of interest 3D three-dimensional 1 From the

More information

Renal Cancer: Symptoms, diagnosis, pathology & prognosis

Renal Cancer: Symptoms, diagnosis, pathology & prognosis Renal Cancer: Symptoms, diagnosis, pathology & prognosis Mark Johnson Consultant Urological Surgeon Newcastle upon Tyne Hospitals NHS Foundation Trust Plan for today: How renal tumours present What investigations

More information

Case Report. Central Neurocytoma. Fotis Souslian, MD; Dino Terzic, MD; Ramachandra Tummala, MD. Department of Neurosurgery, University of Minnesota

Case Report. Central Neurocytoma. Fotis Souslian, MD; Dino Terzic, MD; Ramachandra Tummala, MD. Department of Neurosurgery, University of Minnesota 1 Case Report Central Neurocytoma Fotis, MD; Dino Terzic, MD; Ramachandra Tummala, MD Department of Neurosurgery, University of Minnesota Case This is a previously healthy 20 year old female, with 3 months

More information

Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care

Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care Measure #405: Appropriate Follow-up Imaging for Incidental Abdominal Lesions National Quality Strategy Domain: Effective Clinical Care 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS, REGISTRY DESCRIPTION:

More information

Ultrasound - Breast. What is Ultrasound Imaging of the Breast?

Ultrasound - Breast. What is Ultrasound Imaging of the Breast? Scan for mobile link. Ultrasound - Breast Ultrasound imaging of the breast uses sound waves to produce pictures of the internal structures of the breast. It s primarily used to help diagnose breast lumps

More information

X-Plain Breast Cancer Reference Summary

X-Plain Breast Cancer Reference Summary X-Plain Breast Cancer Reference Summary The risk of breast cancer among Asian Americans living in the U.S. is relatively low compared to caucasian women. However, there is concern that the risk of breast

More information

Middle-aged Woman With a Focal Liver Lesion on Imaging. Objectives

Middle-aged Woman With a Focal Liver Lesion on Imaging. Objectives Middle-aged Woman With a Focal Liver Lesion on Imaging Bilal Hameed, MD University of California, San Francisco Objectives Common liver lesions seen in women on imaging Describe key findings on imaging

More information

Diffusion-weighted MR imaging in lymphadenopathy for differentiation of malignant lymphoma, metastatic lymph node and benign lymphadenopathy

Diffusion-weighted MR imaging in lymphadenopathy for differentiation of malignant lymphoma, metastatic lymph node and benign lymphadenopathy Diffusion-weighted MR imaging in lymphadenopathy for differentiation of malignant lymphoma, metastatic lymph node and benign lymphadenopathy Poster No.: R-0089 Congress: RANZCR-AOCR 2012 Type: Scientific

More information

Diagnostic Slide Session Case Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA

Diagnostic Slide Session Case Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA Diagnostic Slide Session Case 2015-2 Jennifer Ziskin MD, PhD, and Edward D Plowey MD, PhD Stanford University, Stanford, CA Clinical History: 18 year old woman with right facial pain and hyperalgesia Past

More information

Uterine Fibroids: Not As Simple As You Think.

Uterine Fibroids: Not As Simple As You Think. Uterine Fibroids: Not As Simple As You Think jeffrey.weinreb@yale.edu Uterine Leiomyoma Most common uterine neoplasm 20-30% women >35yo Under hormonal influence Enlarge during pregnancy or BCP use Regress

More information

The TV Series. www.healthybodyhealthymind.com INFORMATION TELEVISION NETWORK

The TV Series. www.healthybodyhealthymind.com INFORMATION TELEVISION NETWORK The TV Series www.healthybodyhealthymind.com Produced By: INFORMATION TELEVISION NETWORK ONE PARK PLACE 621 NW 53RD ST BOCA RATON, FL 33428 1-800-INFO-ITV www.itvisus.com 2005 Information Television Network.

More information

Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1

Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1 Mesothelioma Introduction Mesothelioma is a type of cancer. It starts in the tissue that lines your lungs, stomach, heart, and other organs. This tissue is called mesothelium. Most people who get this

More information

Case Report: Whole-body Oncologic Imaging with syngo TimCT

Case Report: Whole-body Oncologic Imaging with syngo TimCT Case Report: Whole-body Oncologic Imaging with syngo TimCT Eric Hatfield, M.D. 1 ; Agus Priatna, Ph.D. 2 ; John Kotyk, Ph.D. 1 ; Benjamin Tan, M.D. 1 ; Alto Stemmer 3 ; Stephan Kannengiesser, Ph.D. 3 ;

More information

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11

More information

Benign Liver Tumors. Cameron Schlegel PGY-1 3/6/2013

Benign Liver Tumors. Cameron Schlegel PGY-1 3/6/2013 Benign Liver Tumors Cameron Schlegel PGY-1 3/6/2013 Outline Benign Liver Tumors are, in general. Asymptomatic Diagnosed: imaging Treatment: Do no harm Unless Malignant potential Causing symptoms Differential

More information

Imaging techniques such as computed tomography (CT) and magnetic resonance (MR) imaging are used widely to evaluate renal masses ( 1,2 ). Many of thes

Imaging techniques such as computed tomography (CT) and magnetic resonance (MR) imaging are used widely to evaluate renal masses ( 1,2 ). Many of thes Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Sachit K. Verma,

More information

Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy

Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy Sarah Hutto,, MSIV Marc Underhill, M.D. January 27, 2009 Past History 45 yo female

More information

RCC. RENAL CELL CARCINOMA the most common form of kidney cancer UNDERSTANDINGRCC

RCC. RENAL CELL CARCINOMA the most common form of kidney cancer UNDERSTANDINGRCC RCC RENAL CELL CARCINOMA the most common form of kidney cancer UNDERSTANDINGRCC RENAL CELL CARCINOMA ABOUT THIS GUIDE This guide will: Help you understand renal cell carcinoma (RCC) Provide information

More information

Imaging of Normal and Abnormal Vertebral bone Marrow

Imaging of Normal and Abnormal Vertebral bone Marrow Imaging of Normal and Abnormal Vertebral bone Marrow Dr Philippa Tyler Consultant Radiologist The Royal National Orthopaedic Hospital, Stanmore Systematic review marrow change (fat / oedema/ sclerosis/fibrosis/

More information

Ultrasound of Benign Pathology. Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine

Ultrasound of Benign Pathology. Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine Ultrasound of Benign Pathology Reni Butler, M.D. Department of Radiology and Biomedical Imaging Yale School of Medicine Ultrasound of Benign Pathology Cyst Intramammary Lymph Node Lipoma Fibroadenolipoma

More information

Male Breast Cancer Published on Diagnostic Imaging (http://www.diagnosticimaging.com)

Male Breast Cancer Published on Diagnostic Imaging (http://www.diagnosticimaging.com) Case Studies [1] July 22, 2014 By Danielle DeMulder, MD [2] and Erini Makariou, MD [3] Case History: 54-year-old male presents with palpable right retroareolar abnormality. Case History: 54-year-old male

More information

MRI of Bone Marrow Radiologic-Pathologic Correlation

MRI of Bone Marrow Radiologic-Pathologic Correlation MRI of Bone Marrow Radiologic-Pathologic Correlation Marilyn J. Siegel, M.D. Mallinckrodt Institute of Radiology Washington University School of Medicine St. Louis, MO and Visiting Scientist, AFIP, Washington,

More information

Neuroendocrine Tumors: A Review of CT and MRI Findings Pareen Mehta, MD and Patrick M. Colletti, MD

Neuroendocrine Tumors: A Review of CT and MRI Findings Pareen Mehta, MD and Patrick M. Colletti, MD Neuroendocrine Tumors: A Review of CT and MRI Findings Pareen Mehta, MD and Patrick M. Colletti, MD Neuroendocrine tumors, including pancreatic neuroendocrine tumors and carcinoid tumors, are rare neoplasms

More information

Whole Body MRI in Oncology: Neuroblastoma and Lymphoma. Whole Body MRI in Oncology. WB-MRI Techniques. Without a Moving Tabletop

Whole Body MRI in Oncology: Neuroblastoma and Lymphoma. Whole Body MRI in Oncology. WB-MRI Techniques. Without a Moving Tabletop Whole Body MRI in Oncology: Neuroblastoma and Lymphoma Marilyn J. Siegel, M.D. Mallinckrodt Institute of Radiology Washington University Medical Center St. Louis, MO Whole Body MRI in Oncology Describe

More information

What's the Best Approach to Evaluate the Liver Mass?

What's the Best Approach to Evaluate the Liver Mass? WHAT IS THE BEST WAY TO EVALUATE THE LIVER MASS? Mitchell L Shiffman, MD Chief, Hepatology Section Virginia Commonwealth University Medical Center Richmond, VA LIVER MASSES DISCOVERY AND SIGNIFICANCE Incidental

More information

Diffusion MRI of the Abdomen

Diffusion MRI of the Abdomen Diffusion MRI of the Abdomen Robert R. Edelman, M.D. Dept. of Radiology NorthShore University Health System Feinberg School of Medicine, Northwestern University Diffusion Imaging Random motion of molecules

More information

Design of Anatomically Accurate, Patient-Specific Renal Tumor Models for Partial Nephrectomy

Design of Anatomically Accurate, Patient-Specific Renal Tumor Models for Partial Nephrectomy Design of Anatomically Accurate, Patient-Specific Renal Tumor Models for Partial Nephrectomy Nicole Wake 1,2, William Huang 3, Hersh Chandarana 1 1 The Center for Advanced Imaging Innovation and Research

More information

and Malignant Compression Fractures of the Spine : Value of Adding Axial Diffusion-weighted MR Imaging at 3.0 T

and Malignant Compression Fractures of the Spine : Value of Adding Axial Diffusion-weighted MR Imaging at 3.0 T and Malignant Compression Fractures of the Spine : Value of Adding Axial Diffusion-weighted MR Imaging at 3.0 T < SP47, Scientific abstract > Jinkyeong Sung, MD1, Won-Hee Jee, MD1, Joon-Yong Jung, MD1,

More information

Diagnosis of Breast Lesions with MRI

Diagnosis of Breast Lesions with MRI Diagnosis of Breast Lesions with MRI George Trilikis, M.D. October 2, 2010 Breast MRI Indications Overview Is breast MRI the best test? Key concepts to high quality breast MRI What are some things a technologist

More information

Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer.

Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer. Renal cell cancer Renal cell cancer is a disease in which malignant (cancer) cells form in tubules of the kidney. Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which

More information

34 YOM potential living liver donor. 38 YO male living liver donor candidate. Adenomatosis. FNH vs Adenoma

34 YOM potential living liver donor. 38 YO male living liver donor candidate. Adenomatosis. FNH vs Adenoma 34 YOM potential living liver donor 38 YO male living liver donor candidate Adenomatosis FNH vs Adenoma FNH Hepatobiliary agents have a role in distinguishing the two! Adenoma But beware 3 minute post

More information

Kidney cases. Case 1: 50 year old with hematuria

Kidney cases. Case 1: 50 year old with hematuria Kidney cases Bruce Lehnert MD Body Imaging and Emergency Radiology University of Washington Case 1: 50 year old with hematuria What is the most likely diagnosis? A: Angiomyolipoma B: Renal lymphoma C:

More information

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too.

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast

More information

Fat-containing lesions of the liver: What do we need to know about them?

Fat-containing lesions of the liver: What do we need to know about them? Fat-containing lesions of the liver: What do we need to know about them? C. Santos Montón, S. del Carmen Martínez, M. Martin Izquierdo, D. C. Cuellar, A. Herrero Hernandez, J. F. Ojeda Esparza; Salamanca/ES

More information

MRI for Paediatric Surgeons

MRI for Paediatric Surgeons MRI for Paediatric Surgeons Starship David Perry Paediatric Radiologist Starship Children s Hospital CHILDREN S HEALTH What determines the brightness of a pixel in MRI? i.e. What determines the strength

More information

MRI of benign and focal liver lesions. Dr Nick Woodward Royal Free London

MRI of benign and focal liver lesions. Dr Nick Woodward Royal Free London MRI of benign and focal liver lesions Dr Nick Woodward Royal Free London Introduction Focal liver lesions Benign Characterisation of lesions seen on other modalities Characterisation of benign hepatocellular

More information

THYROID CANCER. I. Introduction

THYROID CANCER. I. Introduction THYROID CANCER I. Introduction There are over 11,000 new cases of thyroid cancer each year in the US. Females are more likely to have thyroid cancer than men by a ratio of 3:1, and it is more common in

More information

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke

Open the Flood Gates Urinary Obstruction and Kidney Stones. Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Open the Flood Gates Urinary Obstruction and Kidney Stones Dr. Jeffrey Rosenberg Dr. Emilio Lastarria Dr. Richard Kasulke Nephrology vs. Urology Nephrologist a physician who has been trained in the diagnosis

More information

CONTRAST-ENHANCED ULTRASOUND OF THE LIVER:

CONTRAST-ENHANCED ULTRASOUND OF THE LIVER: CONTRAST-ENHANCED ULTRASOUND OF THE LIVER: ELECTRONIC ATLAS OF NORMAL ANATOMY, COMMON & UNCOMMON PATHOLOGY, & GUIDANCE FOR PROCEDURES Mollie Rashid, MD Corinne Deurdulian, MD Suzanne L. Palmer, MD DISCLOSURES

More information

MAGNETOM Aera Combining Throughput and Highest Quality Spine Imaging in an Optimized Clinical Workflow

MAGNETOM Aera Combining Throughput and Highest Quality Spine Imaging in an Optimized Clinical Workflow Clinical Orthopedic Imaging MAGNETOM Aera Combining Throughput and Highest Quality Spine Imaging in an Optimized Clinical Workflow Johan Dehem, M.D. VZW Jan Yperman, Ieper, Belgium Cervical spine imaging

More information

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases.

Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Metastatic Renal Cell Carcinoma: Staging and Prognosis of Three Separate Cases. Abstract This paper describes the staging, imaging, treatment, and prognosis of renal cell carcinoma. Three case studies

More information

OBJECTIVES By the end of this segment, the community participant will be able to:

OBJECTIVES By the end of this segment, the community participant will be able to: Cancer 101: Cancer Diagnosis and Staging Linda U. Krebs, RN, PhD, AOCN, FAAN OCEAN Native Navigators and the Cancer Continuum (NNACC) (NCMHD R24MD002811) Cancer 101: Diagnosis & Staging (Watanabe-Galloway

More information

Four Important Facts about Kidney Cancer

Four Important Facts about Kidney Cancer Volume Article.13-11 Publish Date: 24th June 2013 Author(s): MPUH - CRS Team Four Important Facts about Kidney Cancer ARTICLE hhh Muljibhai Patel Urological Hospital (MPUH) Centre For Robotic Surgery (CRS)

More information

Ultrasound - Scrotum. What is Ultrasound Imaging of the Scrotum? What are some common uses of the procedure?

Ultrasound - Scrotum. What is Ultrasound Imaging of the Scrotum? What are some common uses of the procedure? Scan for mobile link. Ultrasound - Scrotum Ultrasound imaging of the scrotum uses sound waves to produce pictures of a man s testicles and surrounding tissues. It is the primary method used to help evaluate

More information

FieldStrength. Asan Medical Center proves the power of pediatric whole body MRI

FieldStrength. Asan Medical Center proves the power of pediatric whole body MRI FieldStrength Publication for the Philips MRI Community Issue 38 Summer 2009 Asan Medical Center proves the power of pediatric whole body MRI New approaches for pediatric whole body MRI help visualize

More information

Segmental Testicular Infarction: Conservative Management is Feasible and Safe

Segmental Testicular Infarction: Conservative Management is Feasible and Safe european urology 53 (2008) 441 445 available at www.sciencedirect.com journal homepage: www.europeanurology.com Case Study of the Month Segmental Testicular Infarction: Conservative Management is Feasible

More information

In Practice Whole Body MR for Visualizing Metastatic Prostate Cancer

In Practice Whole Body MR for Visualizing Metastatic Prostate Cancer In Practice Whole Body MR for Visualizing Metastatic Prostate Cancer Prostate cancer is the second most common cancer in men worldwide, accounting for 15% of all new cancer cases. 1 Great strides have

More information

95% of childhood kidney cancer cases are Wilms tumours. Childhood kidney cancer is extremely rare, with only 90 cases a year in

95% of childhood kidney cancer cases are Wilms tumours. Childhood kidney cancer is extremely rare, with only 90 cases a year in James Whale Fund for Kidney Cancer Childhood kidney cancer factsheet Kidney cancer rarely afflicts children and about 90 paediatric cases are diagnosed in the UK each year. About 75% of childhood kidney

More information

Breast Imaging East Duarte Road Duarte, CA HOPE MED M

Breast Imaging East Duarte Road Duarte, CA HOPE  MED M Breast Imaging 1500 East Duarte Road Duarte, CA 91010-3000 800.826.HOPE www.cityofhope.org MED 8116 0607 25M Breast Imaging Benefits of Early Detection One out of eight women in the U.S. will develop breast

More information

Pancreatic masses: What is there besides cancer

Pancreatic masses: What is there besides cancer Pancreatic masses: What is there besides cancer Poster No.: C-0201 Congress: ECR 2010 Type: Educational Exhibit Topic: Abdominal Viscera (Solid Organs) Authors: M. A. Portilha, C. Ruivo, I. Santiago, M.

More information

October 2012 Pulmonary Case of the Month: Hemoptysis from an Uncommon Cause. Lewis J. Wesselius, MD

October 2012 Pulmonary Case of the Month: Hemoptysis from an Uncommon Cause. Lewis J. Wesselius, MD October 2012 Pulmonary Case of the Month: Hemoptysis from an Uncommon Cause Lewis J. Wesselius, MD Department of Pulmonary Medicine Mayo Clinic Arizona Scottsdale, AZ History of Present Illness A 39 year

More information

Giant-cell tumor of the tendon sheath: when must we suspect it?

Giant-cell tumor of the tendon sheath: when must we suspect it? Giant-cell tumor of the tendon sheath: when must we suspect it? C. Santos Montón, J. M. Alonso Sánchez, D. C. Cuellar, P. A. Chaparro García, R. Corrales, J. D. Albillo Labarra; Salamanca/ES Learning objectives

More information

Liver Cancer What is the liver? What is liver cancer?

Liver Cancer What is the liver? What is liver cancer? Liver Cancer What is the liver? The liver is the largest internal organ in the body and is important in digesting food. The liver performs many other functions, including collecting and filtering blood

More information

Benign Ovarian Masses

Benign Ovarian Masses Benign Ovarian Masses Anthony Hanbidge Learning Objectives Describe technique for assessment of ovarian masses Explain importance of transvaginal scan List the common benign masses Specify distinguishing

More information

MRI of Benign Liver Lesions and Metastatic Disease Characterization with. Gadoxetate Disodium

MRI of Benign Liver Lesions and Metastatic Disease Characterization with. Gadoxetate Disodium MRI of Benign Liver Lesions and Metastatic Disease Characterization with Gadoxetate Disodium Rocky C. Saenz, D.O. Department of Diagnostic Radiology, Botsford Hospital, Farmington Hills, MI Introduction

More information

Sigmoid Stenosis caused by diverticulitis versus carcinoma: Can they be differentiated by ultrasound?

Sigmoid Stenosis caused by diverticulitis versus carcinoma: Can they be differentiated by ultrasound? Sigmoid Stenosis caused by diverticulitis versus carcinoma: Can they be differentiated by ultrasound? T Ripollés, MD; MJ Martínez, MD; C Fernández, MD; J Vizuete, MD; D Gómez, MD; G Martín, MD. Department

More information

Lung Cancer. This reference summary will help you better understand lung cancer and the treatment options that are available.

Lung Cancer. This reference summary will help you better understand lung cancer and the treatment options that are available. Lung Cancer Introduction Lung cancer is the number one cancer killer of men and women. Over 165,000 people die of lung cancer every year in the United States. Most cases of lung cancer are related to cigarette

More information

Study of minor abnormalities. Minor adrenal abnormalities. Example. Example. Pseudoadrenal mass. Teaching point. Minor thickening or nodularity of

Study of minor abnormalities. Minor adrenal abnormalities. Example. Example. Pseudoadrenal mass. Teaching point. Minor thickening or nodularity of Pitfalls in Genitourinary Imaging Objectives Fergus Coakley MD, Professor of Radiology and Urology, Vice Chair for Clinical Services, Chief of Abdominal Imaging, UCSF Review sources of error in GU imaging

More information

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma August 2009 To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma Christina Ramirez, Harvard Medical School Year III Gillian Lieberman, MD Agenda

More information

Management of Abdominal Incidentalomas Found on Cross-sectional Imaging: Management Strategies

Management of Abdominal Incidentalomas Found on Cross-sectional Imaging: Management Strategies Management of Abdominal Incidentalomas Found on Cross-sectional Imaging: Management Strategies Michael Nipper, M.D. Q1: What Percentage of the Time Does My Radiology Group Give Specific Follow-up Recommendations

More information

RENAL ANGIOMYOLIPOMA EMBOLIZATION

RENAL ANGIOMYOLIPOMA EMBOLIZATION RENAL ANGIOMYOLIPOMA EMBOLIZATION The information about renal angiomyolipomas on the next several pages includes questions commonly asked about the embolization procedure. Please take a few moments to

More information

Understanding breast changes

Understanding breast changes Understanding breast changes UHN For women Read this resource to learn: Parts of your breast Types of breast changes What follow up appointments you may need Breast Imaging Department Princess Margaret

More information

Renal Cell Carcinoma The New Frontier (To boldly go... ) Sean A. Pierre, MD, RCPSC (Urology)

Renal Cell Carcinoma The New Frontier (To boldly go... ) Sean A. Pierre, MD, RCPSC (Urology) The New Frontier (To boldly go... ) Sean A. Pierre, MD, RCPSC (Urology) QUEENSWAY CARLETON HOSPITAL DIVISION OF UROLOGY NEPEAN, ON, CANADA Disclosures None Objectives Advances in the field of Renal Cell

More information

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc. Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs

More information

Imaging for Lumbar Degenerative Disc Disease

Imaging for Lumbar Degenerative Disc Disease Imaging for Lumbar Degenerative Disc Disease Muhammad A. Munir, MD Diplomat American Board of Anesthesiology and Pain Management Spectrum of Imaging Modalities Radiography, Fluoroscopy and techniques modified

More information

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011 Abdominal Emergency Cases Jeff Dunkle, MD February 2011 Case: Trauma Case: Trauma Dx? Dx: Shock Bowel Hypoperfusion complex Seen in patients with hypovolemic shock. Poor prognostic indicator. CT findings

More information

Metastatic Cancer: Questions and Answers. Key Points

Metastatic Cancer: Questions and Answers. Key Points CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Metastatic Cancer: Questions

More information

Something Old, Something New.

Something Old, Something New. Something Old, Something New. Michelle A. Fajardo, D.O. Loma Linda University Medical Center Clinical Presentation 6 year old boy, presented with hematuria Renal mass demonstrated by ultrasound & CT scan

More information

Molecular Imaging and Prostate Cancer

Molecular Imaging and Prostate Cancer Molecular Imaging and Prostate Cancer Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. Based on rates from 2004 2006, the National Cancer Institute

More information

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA)

NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) Merat Esfahani, MD Medical Oncologist, Hematologist Cancer Liaison Physician SwedishAmerican Regional Cancer Center

More information

Clinical Analysis of Focal Nodular Hyperplasia of the Liver in 11 Patients

Clinical Analysis of Focal Nodular Hyperplasia of the Liver in 11 Patients Clinical Analysis of Focal Nodular Hyperplasia of the Liver in 11 Patients Purpose: The purpose of this study was to determine the clinical features of focal nodular hyperplasia (FNH) and investigate its

More information

Catheter Embolization and YOU

Catheter Embolization and YOU Catheter Embolization and YOU What is catheter embolization? Embolization therapy is a minimally invasive (non-surgical) treatment that occludes or blocks one or more blood vessels or vascular channels

More information

Assessment of Thyroid Nodules (AACE.com for Guidelines) March, 2007

Assessment of Thyroid Nodules (AACE.com for Guidelines) March, 2007 Assessment of Thyroid Nodules (AACE.com for Guidelines) March, 2007 Prevalence: palpable 3-7% (6.4% of women and 1.5% of men); ultrasound ~50% More common in elderly and those with iodine deficiency or

More information

Imaging of Soft Tissue Tumors

Imaging of Soft Tissue Tumors Imaging of Soft Tissue Tumors Leanne L Seeger, MD, FACR Professor & Chief, Musculoskeletal Imaging David Geffen School of Medicine at UCLA Department of Radiology Objectives 1. Apply understanding and

More information

Intestinal Cancer. Intestinal cancer is rare. But eating a high-fat diet or having certain digestive diseases can raise a person s risk.

Intestinal Cancer. Intestinal cancer is rare. But eating a high-fat diet or having certain digestive diseases can raise a person s risk. Intestinal Cancer Introduction This reference summary discusses cancer of the small intestines, not cancer of the colon. Intestinal cancer starts in the cells of the small intestine. The small intestine

More information

Liver Imaging. Liver Imaging/Cirrhosis. Signs of Liver Failure and Portal Hypertension. Methods of Imaging the Liver. CT Workhorse of Imaging

Liver Imaging. Liver Imaging/Cirrhosis. Signs of Liver Failure and Portal Hypertension. Methods of Imaging the Liver. CT Workhorse of Imaging Liver Imaging Patricia Lipford Abbitt,, MD Professor and Chief - Body Imaging Section Department of Radiology College of Medicine University of Florida Liver Imaging/Cirrhosis Number of patients with hepatitis

More information

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them.

Brain Cancer. This reference summary will help you understand how brain tumors are diagnosed and what options are available to treat them. Brain Cancer Introduction Brain tumors are not rare. Thousands of people are diagnosed every year with tumors of the brain and the rest of the nervous system. The diagnosis and treatment of brain tumors

More information

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver.

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver. EXTRAHEPATIC BILE DUCT CANCER General Information Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver. A network of

More information

An Introduction to Cancer and Basic Cancer Vocabulary

An Introduction to Cancer and Basic Cancer Vocabulary An Introduction to Cancer and Basic Cancer Vocabulary Marc B. Garnick, MD Beth Israel Deaconess Medical Center Harvard Medical School, Boston Medical Director Cancer Programs Northeast Hospital Corporation,

More information

Patient s renal function

Patient s renal function Gadolinium Bolus Contrast Enhanced MRA Wm. Faulkner, B.S.,R.T.(R)(MR)(CT), FSMRT Largely eliminates flow artifacts seen on TOF or PC sequences Image contrast dependent on differences between T1 of gad

More information